الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
For severe cases of rheumatic mitral stenosis, BMV has become the preferred method of treatment. The procedure’s immediate results have improved and the rate of problems has reduced with increasing experience and better patient selection.
A novel matrix-based ultrasound probe has made it possible for 3D echo to provide more thorough morphologic study of the MV apparatus, including subvalvular and commissural involvement and calcification..
The VHD assessment process used by CMR is accurate and repeatable. It can sometimes provide insight into the severity and mechanism of valve lesions and offers a number of advantages over TTE. Additionally, it enables an accurate assessment of lesions with multiple regurgitant jets or eccentric jets as well as a thorough evaluation of valvular flow and function. Additionally, it has been demonstrated that left ventricular (LV) function and remodeling can be accurately and consistently assessed by CMR.
In our study we aimed to assess valve morphology in patients with rheumatic mitral stenosis undergoing balloon mitral valvoplasty by CMR, (2D) and 3D echocardiography and predicting success of the procedure.
We also aim to correlate the presence of commissural calcification and degree of commissural splitting by different imaging modality with outcome.
This prospective non randomized study included consecutive fifty patients with patients had rheumatic mitral valve (MV) stenosis, and were scheduled for balloon mitral valvuloplasty (BMV) in cardiology departments of Minia and Assiut University hospitals during the period from May 2022 to May 2023.
All candidates were subjected to informed consent ,thorough history taking , resting surface 12-leads ECG and 2D and 3D echocardiography and CMR for evaluation of the mitral valve morphology ,MVA ,commissural splitting and calcification.
This study demonstrated that there was significant increase in MVA after BMV measured by 2D ,3D echocardiography and CMR and there was no significant deference in MVA assessed by CMR and other imaging modality included 2D ,3D transthoracic echocardiography and 3D trans esophageal echocardiography. The best agreement in measured MVA was by CMR and that with 3D echocardiography and 3D transesophageal echocardiography Pre BMV.
Additionally, there was correlation between the commissure splitting score and the post-procedure MVA; that is, the more the commissure fusion (low score) prior to BMV, the larger the post-BMV MVA.
Also, Patients with commissural calcification have a higher incidence of increasing the degree of mitral regurgitation post BVM.
We concluded that CMR provide reliable method for assessment MVA in patients with MS undergoing BMV without significant difference with 2D & 3D echocardiography.
Based on our results we recommend proper evaluation of mitral valve commissural splitting and calcification before selecting patients for balloon mitral valvuloplasty even in cases with favorable Wilkins score.